Has your doctor ever said you have heart trouble? *
Do you frequently have pains in your heart and chest? *
Do you often feel fain or have spells of severe dizziness? *
Has a doctor ever said your blood pressure was too high? *
Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that has been aggravated by exercise, or might be made worse with exercise?
Is there a good physical reason, not mentioned here, why you should not follow an activity program even if you wanted to? *
Are you or have you been pregnant in the last 6 months? *
Do you suffer from any problems of the lower back, i.e., chronic pain, or numbness? *
Are you currently taking any medications? *
Do you currently have a disability or a communicable disease? *